Hormone Replacement Therapy

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Hormone Replacement Therapy
Martha Petersen MPH, CHES, PA-C Womens Health
Module Summer2001 PA Program Lock Haven University
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Cycle

• Pituitary FSH
• Ovulation LH
• Ovaries
• Estrogen
• Progesterone
• Androgens
• ?????????

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Premature Ovarian Failure

• Spontaneous cessation of menses
• POF elevated FSH x 2
• R/O autoimmune disorder
• Karyotypic abnormalities

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PeriMenopause

• Change in menses
• Vasomotor symptoms

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Menopause

• Amenorrhea
• Vasomotor symptoms (cultural?)
• Definitive Dx FSH
• 40 mIU (x2) Amenorrhea (6months)

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FSH Levels
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Menopause

• Average age 50 52
• 40-60 normal
• Genetic Influence
• Early Menarche Late Menopause
• Hysterectomy Earlier Menopause
• Smoking Earlier Menopause
• Chemotherapy /or Radiation

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HRT Indications

• Symptoms of Hormonal Deficiency
• Prevention of Specific Medical Conditions

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HRT Benefits

• Symptomatic
• Vasomotor
• Mood
• Vaginal Atrophy
• Insomnia

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HRT Benefits

• Preventative
• Osteoporosis
• Coronary Heart Dz
• Alzheimers
• Genitourinary Health
• Colon Cancer
• Atrophic Vaginitis
• General Sense of Well Being
• Sexual Functioning

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HRT RISK

• Breast Ca
• Deep Vein Thrombosis (DVT)
• Pulmonary Emboli (PE)
• Endometrial Ca
• Gallbladder Dz
• Systemic Lupus Erythematosus

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ESTROGENS
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Progestins
Not FDA Approved
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Androgens

• Part of the hormones lost w/ cessation of
  ovarian function
• Contributes to bone density, libido and sense of
  general well being
• Methyltestosterone 1.25 5.0 mg

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Alternative Rx for Vasomotor Sx
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Delivery Method

• Oral
• Transdermal
• Transvaginally
• IM

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HRT Contraindications

• Absolute
• Temporary
• Relative

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HRT for Whom?

• Individualize to Patient
• Symptoms?
• Personal History?
• Family History?

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HRT Regimen

• Provides Benefits
• Minimize SE
• Cyclic vs Continuous

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HRT - Cyclic

• Estrogen qd
• .3 mg minimum dose for Osteo
• Progestin 2.5 5.mg
• Minimum of 12 days /cycle of estrogen
• May have w/drawal bleeding

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HRT Continuous

• Estrogen qd
• .3 for Osteo
• .625 most common
• .9 or 1.25 if needed
• Progesterone qd
• 2.5 mg
• 5 mg if needed

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HRT Rx

• http//www.earlymenopause.com/hrt.htm
• http//www.imaginis.com/breasthealth/hrt.asp

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HRT Secrets to Success

• Individualize to Patient
• Educate
• Re Evaluate
• Reassure

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References

• Johnson S. Menopause and Hormone Replacement
  Therapy (2000)
• Sheehey G. Silent Passages ( 1998)
• Sullivan J, Fowlkes L. Changing the Natural
  History of Coronary Artery Disease (1999)
• http//www.earlymenopause.com/links.htm
• http//www.imaginis.com/breasthealth/hrt.asp